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After the Battle*

After the Battle, Fighting the Bottle at Home
July 09, 2008 / Military.com

Most nights when Anthony Klecker, a former marine, finally slept, he found himself back on the battlefields of Iraq. He would awake in a panic, and struggle futilely to return to sleep.

Days were scarcely better. Car alarms shattered his nerves. Flashbacks came unexpectedly, at the whiff of certain cleaning chemicals. Bar fights seemed unavoidable; he nearly attacked a man for not washing his hands in the bathroom.

Desperate for sleep and relief, Mr. Klecker, 30, drank heavily. One morning, his parents found him in the driveway slumped over the wheel of his car, the door wide open, wipers scraping back and forth. Another time, they found him curled in a fetal position in his closet.

Yet only after his drunken driving caused the death of a 16-year-old cheerleader did Mr. Klecker acknowledge the depth of his problem: His eight months at war had profoundly damaged his psyche.

I was trying to be the tough marine I was trained to be not to talk about problems, not to cry, said Mr. Klecker, who has since been diagnosed with severe post-traumatic stress disorder. I imprisoned myself in my own mind.

Mr. Kleckers case is part of a growing body of evidence that alcohol abuse is rising among veterans of combat in Afghanistan and Iraq, many of them trying to deaden the repercussions of war and disorientation of home. While the numbers remain relatively small, experts say and studies indicate that the problem is particularly prevalent among those suffering from post-traumatic stress disorder, as it was after Vietnam. Studies indicate that illegal drug use, much less common than heavy drinking in the military, is up slightly, too.

Increasingly, these troubled veterans are spilling into the criminal justice system. A small fraction wind up in prison for homicides or other major crimes. Far more, though, are involved in drunken bar fights, reckless driving and alcohol-fueled domestic violence. Whatever the particulars, their stories often spool out in unwitting victims, ruptured families, lost jobs and crushing debt.

With the rising awareness of the problem has come mounting concern about the access to treatment and whether enough combat veterans are receiving the help that is available to them.

Having cut way back in the 1990s as the population of veterans declined, the Veterans Health Administration says it is expanding its alcohol- and drug-abuse services. But advocacy groups and independent experts including members of a Pentagon mental-health task force that issued its report last year are concerned that much more needs to be done. In May, the House and Senate passed bills that would require the veterans agency to expand substance-abuse screening and treatment for all veterans.

The war is now and the problems are now, said Richard A. McCormick, a senior scholar for public health at Case Western Reserve University in Cleveland who served on the Pentagon task force. Every day there is a cohort of men and women being discharged who need services not one or two or five years from now. They need them now.

For active-duty servicemembers, the military faces a shortage of substance-abuse providers on bases across the country, while its health insurance plan, Tricare, makes it difficult for many reservists and their families to get treatment.

In the breach, a few states, including California, Connecticut and Minnesota, have passed laws or begun programs to encourage alternative sentences, often including treatment, for veterans with substance-abuse and mental-health problems.

In recent years, the military has worked to transform a culture that once indulged heavy drinking as part of its warrior ethos into one that discourages it and encourages service members to seek help.

The Army takes alcohol and drug abuse very seriously and has tried for decades to deglamorize its use, said Lt. Col. George Wright, an Army spokesman. With the urgency of this war, we continue to tackle the problem with education, prevention and treatment.

That is a tricky mission in time of war.

The problem in todays military is soldiers have to be warriors, killers, do war, but we dont allow them any releases like we used to, said Bryan Lane, a former special forces sergeant who sustained a traumatic brain injury in Iraq and has post-traumatic stress disorder, or PTSD. You cant go out and drink, you cant get into a fight. Its completely unrealistic.

The military, he said, is trying to create a contradiction: a perfect warrior, and then a perfect gentleman.

Warning Signs Grow

Fort Drum, in the North Country of New York just outside Watertown, is home to the Armys most-deployed brigade the Second Brigade of the 10th Mountain Division. Late last year, several thousand soldiers returned after 15 months in Iraq. Some had served three, even four, tours, and they quickly overwhelmed the bases mental health system. A study by an advocacy group, Veterans for America, found the demand for psychological help was so great, and the system so overburdened, that soldiers often waited a month to be seen.

Many also did what generations of homecoming soldiers have done: they salved their wounds in local bars. With drinking off-limits in Iraq, at least openly, they were that much more likely to binge, that much less able to tolerate it.

The bases commander, Maj. Gen. Michael L. Oates, says that since his arrival in early 2007, misconduct related to substance abuse has reached unacceptable levels, despite a toughened regimen of education, designated-driver programs and penalties.

The rate of illegal drug use is slightly up; the rate of alcohol is more than slightly up, General Oates said. Im not a teetotaler. Im not against people drinking. Im against misconduct.

By last March, he had seen enough. He ordered the bases newspaper, The Fort Drum Blizzard, to publish the names and photographs of all soldiers charged with drunken driving. To date, at least 116 have appeared. Half were combat veterans who had returned in the last year, the general said, though others may have deployed earlier.

Most returning soldiers readjust after a few months. But the general estimated that at least 20 percent turned to heavy drinking or drugs typically the first signal that there is something wrong.

Across the military, the precise dimensions of the problem are elusive, especially since the different branches largely keep their own statistics. Many studies do not distinguish between service members who have seen battle and those who have not. What is more, behavior becomes far harder to track when service members leave the military.

Even so, a variety of surveys, as well as anecdotal evidence and rising alarm in many military communities, indicate growing substance abuse among recent combat veterans. Of particular concern are members of the National Guard and reserves, as well as recently discharged service members, who can lose their bearings outside the camaraderie and structure of the military.

In the Army, which has the bulk of the troops in Iraq and Afghanistan, the Pentagons most recent survey of health-related behavior, conducted in 2005 but released last year, found that for the first time in more than 20 years, roughly a quarter of soldiers surveyed considered themselves regular heavy drinkers defined as having five or more drinks at least once a week. The report called the increase to 24.5 percent in 2005, from 17.2 percent in 1998 an issue of concern.

Perhaps the best monitor of recent combat veterans mental health is the Pentagons postdeployment survey. Reflecting concern about heavy drinking, the latest report, published last November, introduced a question about drinking habits. Of the 88,235 soldiers surveyed in 2005 and 2006, three to six months after returning from war, 12 percent of active-duty troops and 15 percent of reservists acknowledged having problems with alcohol.

While drug use decreased substantially after 1980, when the military cracked down, it has increased slightly in the Army and the Marines since 2002, the behavioral survey said. Experts say that, in some cases, troubled combat veterans are more prone to use drugs after leaving the military.

In general, studies find that drinking is more prevalent in the military than in the civilian population; the behavioral survey reported that heavy drinking among 18- to 25-year-old men in the Army and the Marines was almost twice as common as among their civilian counterparts.

Heavy drinking or drug use frequently figures in what law enforcement officials and commanders at military bases across the country say is a rising number of crimes and other examples of misconduct involving soldiers, marines and recent veterans.

Alcohol and drug use starts a cascade of worse problems, said Dr. McCormick, the task force member, who recently retired as director of mental health for the state veterans affairs system in Ohio. Its like throwing gasoline on fire.

Most cases involve low-level misconduct. From 2005 to 2006, for example, alcohol-related incidents mostly drunken or reckless driving and disorderly conduct more than tripled at Fort Hood, Tex., according to information released to the Pentagon task force. Other statistics showed a similar pattern throughout the Army, a task force member said.

The Marines, filled with young men drawn by the corps hard-charging image, have traditionally had the militarys highest drinking rates. While the behavior survey showed a slight decrease in heavy drinking after 2002, it showed an increase in binge drinking. The Marines also reported a rise in alcohol-related incidents.

Sometimes, though, substance abuse becomes a factor in major crimes. This year, a New York Times examination of killings in this country by veterans of Iraq and Afghanistan found that drinking or drug use was frequently involved in the crimes. Last month, a soldier at Fort Bliss, outside El Paso, was charged with killing a woman in a drunken-driving accident the third intoxicated soldier there accused of killing a civilian in six months, said the commander, Maj. Gen. Harold B. Bromberg.

Substance abuse frequently figures in suicides, which reached a high in the Army last year; alcohol or drugs were cited in 30 percent of those 115 cases, the Pentagon reported.

Running through many of these soldiers lives is combat trauma or other mental scars of war.

Research has shown that the likelihood of mental health problems rises with the intensity of combat exposure. (In a recent RAND Corporation study, one in five veterans of Iraq and Afghanistan reported symptoms of combat stress or major depression.) In turn, service members with such problems more often report heavy drinking or illicit drug use.

In part, this dynamic is rooted in the warrior code. Trained to be tough and ignore their fear, many combat veterans are reluctant to acknowledge psychic wounds. Or they worry that getting help will damage their careers. And so, like Mr. Klecker, they treat themselves with the liquor bottle or illegal drugs.

Raising Awareness

In the last decade, the military has rolled out a number of programs to deal with excessive drinking. Soldiers carry call-a-cab cards. One base hands out portable breathalyzers. A new online campaign pokes fun at That Guy, a military man who drinks too much and ends up embarrassing himself and in trouble.

Yet many experts and veterans advocates, as well as some military and government officials, agree that treatment continues to lag behind awareness in terms of access, but also in the willingness to use what is there. Studies showing the prevalence of alcohol problems also consistently show how few of those problem drinkers receive treatment.

In the Pentagons postdeployment survey, for example, fewer than a 10th of those reporting alcohol problems had been referred for treatment; only a small fraction received treatment within 90 days. Similarly, in the Pentagon task force data from Fort Hood, only 41 percent of those involved in alcohol-related incidents were referred to the alcohol program.

Mental health experts call these results unsurprising. Just as many combat veterans self-medicate by drinking to quiet their mental storms, so they are loathe to acknowledge their drinking problems and seek treatment.

Military policy can also hold them back. Service members are increasingly encouraged to seek treatment, without fear of punishment. Even so, signing up automatically alerts a commander. That certainty can stir fears of reprisal and discourage others, like chaplains or marital counselors, from referring troops for treatment.

The Pentagon task force recommended changing this policy for soldiers who seek help early, before the drinking or drug use crosses into addiction.

It is a very difficult problem, said Shelley M. MacDermid, a co-chairwoman of the panel and director of the Center for Families at Purdue University. The likely result is that there are folks who want and need treatment who are not getting it, about whom commanders know nothing.

For users of hard drugs, treatment within the military is rare. The military generally discharges them, arguing that they can no longer do their jobs, and refers them to veterans clinics. However, some experts argue that the military should treat some who started using drugs after fighting in war. At Fort Drum, General Oates says he sometimes gives second chances to some soldiers who test positive.

The Army has increased its substance-abuse budget from $38 million in 2004 to $51 million this year. The Marine Corps says its budget is rising, too. Still, recruiting treatment professionals continues to be a challenge, said Col. Elspeth C. Ritchie, a psychiatric consultant to the Army surgeon general. Colonel Ritchie said the Army was recruiting overseas and at home for 330 jobs, and had filled slightly more than half.

In the veterans health system, the cutbacks of the 1990s left only a small network of programs for the most extreme addicts. Today, veterans service organizations say, the system still needs more modern programs offering intense outpatient treatment, detoxification and stabilization services. Some smaller clinics offer bare-bones treatment or none at all, they say, and veterans in rural areas are hard-pressed to find help near home.

At the veterans agency, officials say they share Congresss goal of expanding programs.

Dr. Antonette Zeiss, the deputy chief consultant for mental health, said the agency had rebuilt its programs in the last three years, adding that it had hired 510 counselors and has programs in 90 to 100 of its larger facilities, with 28 more to be added soon. It is also trying to address what many experts say is a growing need: programs for both substance abuse and combat stress.

That need was underscored by a New Jersey study of 292 National Guard members who had returned from Iraq in the last year. The researchers found that 37 percent had experienced problem drinking; for those with post-traumatic stress disorder, the figure rose to 55 percent. Yet among those reporting both, 41 percent received mental health treatment but only 9 percent received help for substance abuse.

Substance abuse, though, must often be treated first, experts say, since it is hard to treat someone for combat stress who is drinking or using drugs. Getting help can be difficult for many combat veterans who rely on the militarys Tricare health plan reservists and National Guard members living far from veterans clinics or military bases, along with some retirees the Pentagon task force found. Finding treatment programs that accept Tricare often ends in frustration, and few residential rehabilitation programs have the accreditation required by the plan.

A small but growing number of state and local authorities are trying to bridge the gaps.

Last January, a city court judge in Buffalo, Robert T. Russell, noticed a surge of recent veterans with substance-abuse and mental-health problems in the citys courtrooms. He created the nations first Veterans Court, where, instead of jail, veterans arrested for low-level crimes, mostly tied to alcohol or drugs, are enrolled in treatment.

Among them is Garry Pettengill.

When Mr. Pettengill, 25, was medically discharged from the Army in 2006, he had been drinking heavily to cope with a back injury and insomnia. Back home with his wife and three children, he came further unglued. He could not keep a job. While his drinking abated, he said, he started smoking marijuana every day and then began selling it. Last February, he was arrested; out on bail, he fantasized about jumping out windows or hanging himself. A call to a suicide hot line sent him to a veterans hospital for nine days.

Then he landed in Veterans Court. He has been clean for five months.

I get punished, obviously, he said, but they want to make sure I do get a job and dont sell drugs and get the substance-abuse treatment I need.

A Troubled Return Home

Anthony Klecker experienced the brutality of war early, enduring ambushes and firefights as one of the first marines to fight from Kuwait to Baghdad and on to Tikrit. What torments him most, though, is the uncertainty.

As the gunner on the rear Humvee in a First Marine Division convoy, Corporal Klecker was charged with making sure that nothing no cars, no Iraqis came too close. In the distance, he saw a man in farmers robes running toward his convoy and fired a warning. Suddenly, a white civilian van came hurtling up the road. Mr. Klecker fired another warning, then let loose several bursts of machine-gun fire at the van and the man. The van stopped.

Mr. Klecker said he did not know if he had killed them though he assumed he did or if they were innocent Iraqis. Still, he says: I was proud. I had a lot of adrenaline. I did my job.

Later, though, the incident no longer seemed so clear-cut. I started to feel a sense of shame, he said, shame about if I did the right thing or didnt.

Before joining the Marines, Mr. Klecker drank and smoked marijuana, but not heavily, said his lawyer, Brockton Hunter. He was once stopped for drinking and driving, but the charge was downgraded to careless driving because his blood-alcohol level was just over the limit.

After Iraq, he shipped out to Okinawa and did what many marines do there: he drank a lot. But it was not until he left the Marines and returned home to suburban St. Paul that his panic attacks, nightmares and insomnia worsened. So did his drinking. He rarely spoke about the war, and only to other veterans.

Soon he racked up arrests for drinking and fighting, and Mr. Hunter persuaded him to go to the Veterans Affairs center for help. As often happens, the experience did not take. Mr. Klecker says he was shuttled from one counselor to another. Trying to talk about Iraq threw him into a panic.

He hit bottom on Oct. 28, 2006, when he drunkenly drove into a highway divider. It dislodged, trapping another driver, Deanna Casey, 16, of Minneapolis, who was killed when a tractor-trailer rammed her small car.

If I could switch my life with Deannas, I would in a heartbeat, Mr. Klecker said. I didnt ask for help, and I should have.

Afterward, Mr. Klecker received a full veterans disability rating for combat stress. At Mr. Kleckers trial for vehicular manslaughter, the judge recognized the wars role in his disintegration and accepted his lawyers request for a special deal: After a year in jail, Mr. Klecker moved into an intensive inpatient program at the St. Cloud veterans facility to deal first with his drinking and then his combat stress.

Deannas mother, Catherine Casey, a Minneapolis police officer, did not welcome the sentence. There are a lot of young men and women who saw horrible things and have done terrible things and have to live with that, she remembered thinking. I thought, Suck it up, Mr. Klecker.

In time, though, she came to see him as a good kid who made bad choices. In prison, she said, he would get worse.

Counselors say Mr. Klecker was a model patient. But he hit a rough patch during the four-week lull a result of scheduling conflicts between alcohol treatment and therapy for combat stress.

Last November, still untreated for combat trauma, Mr. Klecker twice got into heated arguments with fellow patients, a violation of the program's rules. He was forced to leave the inpatient program and wait for an outpatient slot. In February, the judge ruled that Mr. Klecker could not serve his sentence at home and returned him to prison for 19 months.

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